Most people are aware that having a high cholesterol level is a major risk factor for heart disease, strokes and peripheral artery disease. But what is cholesterol? Are changes in diet and lifestyle useful in maintaining healthy cholesterol levels? Do women face different challenges in controlling cholesterol than men do?

To help women learn the answers to these and other questions, the Washington Women's Center is offering a special Lunch and Learn session on Thursday, September 10 featuring Dr. Ranjana Sharma, a family physician at Washington Hospital. Women are invited to bring a lunch and gather in the Washington Women's Center Conference Room at 2500 Mowry Avenue from noon to 1 p.m.

"Cholesterol is made up of lipoproteins," Dr. Sharma explains. "Lipids are basically fats and fat-like substances found naturally in the body. Lipids combined with proteins make up the low-density lipoprotein, or LDL cholesterol, and high-density lipoprotein, or HDL cholesterol. Lipids are essential for life, since they make up part of your body cells' structure and help cells function properly. But having abnormal cholesterol levels can cause problems."

Dr. Sharma offers the following descriptions of the components of your lipid profile, which can be measure with a simple blood test:

* LDL - Often called the "bad" cholesterol, LDL can cause buildup of hard deposits called plaque inside the arteries, resulting in a condition called atherosclerosis. This plaque can rupture and block blood flow, causing heart attacks, strokes or other problems, depending on where the blood flow is blocked. Atherosclerosis also can contribute to peripheral artery disease by cutting off the blood supply to the body's extremities, especially the legs and feet. The more LDL in the blood, the greater the risk for cardiovascular disease.

* HDL - Known as the "good" cholesterol, HDL seems to protect against heart disease and the build-up of plaque in the arteries by helping the body to get rid of the bad cholesterol in the blood. The higher the level of HDL cholesterol, the better.

* Triglycerides - Another form of fat, triglycerides are stored in fat calls throughout the body. High levels of triglycerides may be caused by excess consumption of calories, alcohol, carbohydrates or sugar. People with high levels of triglycerides often have a high LDL level and a low HDL level.

"Another type of lipid in the body is very low-density lipoprotein, or VLDL" Dr. Sharma adds. "VLDL is composed of mostly fat and not much protein, and it also may contribute to buildup of fatty deposits in the arteries."

For women with no additional risk factors for cardiovascular disease, doctors generally recommend a total cholesterol level below 200, with the LDL level lower than 130 and the HDL level higher than 50. Triglycerides should be lower than 150. The level of VLDL can vary substantially, depending on the content of the person's most recent meal.

"People sometimes get confused about which is the 'bad' cholesterol and which is the 'good' cholesterol," Dr. Sharma says. "One way to remember is associating the first letter in each type of lipoprotein with your measurement goal - LDL levels should be low, HDL levels should be high."

How Women Differ from Men

"In childhood, males and females have a similar lipid profile," Dr. Sharma notes. "Around the age of puberty, though, the estrogen level in boys goes down and the level of androgens such as testosterone increases. These changes cause a lower HDL level in men. On average, women have an HDL level that is about 10 points higher than men. When women reach menopause, however, their HDL level drops to a range similar to men's.

"Another factor is that prior to menopause, the LDL in women is made up of larger particles than in men," she adds. "Smaller LDL particles are more likely to clump together and create plaque, so pre-menopausal women have an advantage in that regard."

Female hormones used in birth control pills or for hormone replacement therapy can have an impact on women's cholesterol levels. "Oral estrogen tends to increase the level of HDL and lower the level of LDL," Dr. Sharma explains. "Oral progesterone, on the other hand, decreases the level of HDL and increases LDL.

"Oral hormones have a more pronounced effect than trans-dermal patches, and estrogens applied vaginally have virtually no effect on cholesterol," she continues. "In addition, synthetic hormones have a stronger effect on cholesterol than natural ones. It's also interesting to note that women who have six or more children are at higher risk for developing high cholesterol than women without children."

While hormone replacement therapy may help some women with unpleasant symptoms of menopause such as hot flashes, it is not recommended for use in prevention of cardiovascular disease.

"Clinical trials indicate that hormone replacement therapy may not reduce the risk of heart disease or strokes in post-menopausal women," Dr. Sharma says. "Also, women with a personal or family history of breast cancer should not receive hormone replacement therapy. It's important for women going through menopause to consult with their doctors to weigh the benefits of controlling some symptoms against the risks of hormone replacement therapy."

Risk Factors, Prevention and Treatment

In addition to hormones, a number of other factors can affect a woman's lipid profile, according to Dr. Sharma.

"Smoking can increase the level of LDL and lower the level of HDL," she notes. "The good news, however, is that if a woman stops smoking, her risk of cardiovascular disease drops in approximately two to three years to the same level as a nonsmoker. There are many resources today for helping people to quit smoking, including nicotine gum and patches as well as various oral medications."

Diabetes is a risk factor, as well. "In people with diabetes, the LDL, triglycerides and VLDL levels are usually high, and the HDL level is low," says Dr. Sharma. "Controlling your blood sugar level does help you control your cholesterol levels."

Another factor is obesity. "Women who are obese - especially those with concentrations of fat around the tummy area - have greater risks," Dr. Sharma cautions. "For these people, weight reduction and control can be very important. To lose weight, you need to burn more calories that you take in. For most people than means getting regular, moderate exercise for 60 to 90 minutes each day, depending on your calorie intake. To maintain your current weight, you should get approximately 30 minutes of moderate physical activity every day."

Dr. Sharma also recommend a diet that is high in fruits, vegetables, whole grains and fish, and also low in saturated fats, dietary cholesterol, sugar and salt. "Exercise and a proper diet also will help you keep your blood pressure under control," she adds. "The ideal blood pressure range is below 120/80. People who have a blood pressure between 120/80 and 140/90 may be able to bring it down with changes in their diet and exercise. Those who have a blood pressure over 140/90 may need to consult their physician about medications."

While she prefers to emphasize lifestyle changes as a means of preventing and controlling problems related to high cholesterol, Dr. Sharma does urge patients to consult their physician about medications if they still have elevated levels of cholesterol despite changes in their diet, physical activity, blood sugar and weight.

"For most people, making lifestyle changes is the best way to control your cholesterol and prevent cardiovascular disease," she says. "Only about 25 percent of your blood cholesterol level comes from the food you eat, however. The rest of it is produced in the body by the liver. If you have a history of high cholesterol in your family, your genes may partly determine how much cholesterol your body makes. Modern medications have come a long way in helping to control blood cholesterol levels, including the cholesterol your body makes on its own."

Some of the medications used to treat high cholesterol include statins, niacin, bile-acid resins and fibric-acid derivatives.

"Patients sometimes ask me about over-the-counter medications, such as aspirin, and dietary supplements such as Vitamin E, Vitamin C and beta carotene," Dr. Sharma says. "Aspirin does not control cholesterol. In women over age 65, however, a daily dose of 81 milligrams - which is sometimes referred to as 'baby aspirin' - or a dose of 100 milligrams of aspirin every other day helps prevent blood clots that lead to heart attacks and strokes. A daily dose of aspirin for avoiding heart disease is generally not recommended for women under age 65 unless other risk factors are present.

"Dietary supplements claiming to have anti-oxidant qualities are not recommended for either primary or secondary prevention of cardiovascular disease," she continues. "Supplements have not been proven to have any effectiveness, and they are not worth the cost. You would do better to eat right, exercise and take care of yourself."

Register For Classes Online!

Visit www.whhs.com and register online for the Lunch and Learn session on September 10 or call (800) 963-7070.